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Vehicle Eligibility & Underwriting Guidelines Vehicle Eligibility All eligible vehicles must be 15 model years old or newer and have less than 200,000 miles on the odometer at the time of purchase. Note: January 1st of each year constitutes the model year change. * Vehicles used at any time for: commercial use for business enterprise, trade, profession or occupation; competitive driving; taxi or livery; snow plowing or used for hire to the public or used to transport people for hire; municipal or professional emergency or police services; to tow a trailer whose weight exceeds the manufacturer's recommendations rental, limousine, shuttle, towing/wrecker service; lifting or hoisting; dumping (dump beds); or cherry pickers. Ineligible Vehicles * Vehicles altered or modified in a fashion not recommended by the manufacturer, including installation of high performance equipment, lift or lowering kits, incorrect tires/wheels or removal of any emission devices. * Vehicles that are Kit Cars; High Performance; Exotic or Special Purpose; Engines Over 8 Cylinders; Alternative Fuel (Natural Gas, LP Gas or Propane) or All Electric; or Modified Diesel. * Vehicles with odometers that are broken and/or the correct mileage cannot be determined and verified by the program administrator. One-‐Time Activiation Fee Program Fees & Surcharges $140 Mandatory Business Use Surcharge $10 Business Use Covered Vehicles: Vehicles used for repair work, service work, route work and delivery work (ex: floral delivery, cable TV repair, plumber, vending machine attendant, catering company, medical supply delivery, home repairs, realtor, etc.) Vehicles used for farm use or field work are eligible provided their primary use is for transportation purposes and not used at any time for excessive hauling and/or off-‐road pasture or field work. Coverage is limited to single use drivers. Excluded Vehicles: Vehicles used for commercial towing, dump or refuse collection, hauling, taxi, livery, shuttle, rental, equipped with a snow plow, construction, racing or competitive driving, or emergency services are not eligible for coverage. Vehicles having multiple drivers are not eligible for coverage. Note: Surcharge is required in order to make the vehicle eligible for any coverage. The surcharge provides basic eligibility only, and does not add any additional coverage. 6/2015
Declaration Page VEHICLE OWNER Contract Holder Name: Email: Contract #: Address: City: State: Zip Code: Phone: VEHICLE INFORMATION Year: Make: Model: Current Odometer: Vehicle Identification Number (17 Digits): Vehicle Purchase Price: SELLER INFORMATION Seller Name: Seller Code: Address: City: State: Zip Code: Phone: LIENHOLDER INFORMATION Lienholder Name: Phone: Address: City: State: Zip Code: CONTRACT INFORMATION Contract Purchase Date: Contract Purchase Price: CONTRACT COVERAGE & TERM INFORMATION TERM OF ENROLLMENT: 30 DAYS GoMonthly Coverage TERM OF RENEWAL: 30 DAYS NOTE: This Contract will automatically renew each month unless the Contract Holder cancels benefits or defaults on electronic Contract Renewal Payments voluntarily or involuntarily. This Contract contains a mandatory waiting period of thirty (30) days from the Contract Purchase Date and one thousand (1,000) miles from the odometer at the time of Contract purchase during which no claims may be filed. We will attempt to process each Renewal Payment no later than ten (10) calendar days prior to the scheduled Renewal Date to allow time for notification and/or update to Your payment information on file to be processed. If the Renewal Payment is collected by the Administrator on or before the Renewal Date, the Renewal Term will be in effect: otherwise, the Contract will terminate at the end of the current Renewal Term. MANDATORY SURCHARGES BUSINESS USE If the above described Vehicle is determined to be used for business purposes and the appropriate surcharge was not selected and paid for, no coverage applies. DEDUCTIBLE The Deductible is the amount that You are required to pay per repair visit. ADMINISTRATOR: Dimension Service Corporation, 5500 Frantz Road, Suite 100, Dublin, Ohio 43017, (888) 705-8943 NOTICE: Obligations of the Provider under this Contract are guaranteed by an insurance company. If the Provider (Autoguard Advantage Corporation, 5500 Frantz Road, Suite 100, Dublin, Ohio 43017, (888) 705-8943) fails to pay or provide service on a claim within sixty (60) days after proof of loss has been filed, the Contract Holder is entitled to make a claim against the insurance company. The name and address of the Insurance Company is ANV Syndicates Limited, Lloyd’s Underwriting Syndicate Number 5820, 47 Mark Lane, London EC3R 7QQ, United Kingdom, (888) 705-8941. The undersigned verify that the information contained herein is true and correct to the best of their knowledge. The undersigned Contract Holder has examined and driven the Vehicle and is not aware of any mechanical or electrical defect or problem with the Vehicle. The Contract Holder verifies that He/She has read, understands, and will abide by the terms and conditions of this Contract. No verbal or written representations have been made which may alter the terms and conditions of this Contract. We reserve the right to refuse, cancel, terminate or void any Contract that does not meet Our underwriting guidelines (except in Arizona). This Contract becomes valid only upon acceptance by the Administrator. Purchase of this Contract is not necessary to obtain financing for the Vehicle. This is not an insurance policy. The phone number that I have provided is a mobile number, and I give the company permission to communicate with me via this number. Purchaser Signature Date Seller Representative Signature Date NO CLAIMS WILL BE PAID WITHOUT PRIOR AUTHORIZATION! CLAIMS: (888) 705-8943 6/2015 Page 1 of 4
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